Don't shrink wrap the kids

EVERY generation prides itself on being smarter than the previous one.

 We point to impressive medical advances, huge technological leaps, vastly improved lifestyles, better government, more progressive parenting and so on. But in some areas we are not so smart after all.

Last week The Australian reported on a new study that revealed an increasing number of children were being diagnosed with something called oppositional defiant disorder and other similar behavioural disorders. In the past decade the number of children diagnosed with these disorders has risen from 2.6 per cent to 6.7 per cent. The study by researchers at Macquarie University, to be published in the International Journal of Inclusive Education, found that the diagnosis of conditions such as oppositional defiant disorder had risen by 600per cent in mainstream schools.

Is it possible that the real sickness lies with a society that diagnoses an increasing variety of common childhood behaviour as a disorder? Perhaps we should label modern society as suffering from ODD: obsessive diagnosis disorder.

In 1980 the American Psychiatric Association came up with the label oppositional defiant disorder as a medical diagnosis for a child, as young as three, who exhibits at least four of eight behaviours, including being easily angered, arguing with parents, having frequent tantrums and deliberately annoying others.

Once upon a time children who behaved like this were labelled naughty. Now they are diagnosed with a medical disorder. But they are not alone.

The US surgeon general's report on mental health published in the late 1990s lists a smorgasbord of disorders. While some are serious mental illnesses, such as the eating disorder anorexia nervosa, others are more imprecise, so imprecise I could easily attach the name of someone I know who, though perfectly normal, fulfils enough of the criteria of a disorder to earn a sickness label.

There is separation anxiety disorder for children who are deemed to cling too much to their parents; social anxiety disorder for children who have a persistent fear of being embarrassed in social situations, such as speaking in public; and a catch-all generalised anxiety disorder for children who worry excessively about upcoming events ("they worry about their academic performance or sporting activities"). If these are the tests, most of us are sick or surrounded by people who are.

As The New York Times has reported, more than six million American children with difficulties are diagnosed with serious mental disorders, a threefold increase since the early 90s. The Times reported: "There is little convincing evidence that the rates of illness have increased in the past few decades. Rather, many experts say it is the frequency of diagnosis that is going up, in part because doctors are more willing to attribute behaviour problems to mental illness and in part because the public is more aware of childhood mental disorders."

There are certainly children whose behaviour is so consistently problematic and potentially dangerous as to demand a medical diagnosis and treatment. No doctor wants to do wrong by their patient, just as every parent wants the best for their child. But the modern tendency to draft nebulous criteria to diagnose medical disorders in children offers up its own broader diagnosis of a society obsessed with labelling a disorder any childhood behaviour that deviates from the norm.

The combination of a few modern trends has brought us to this point. Start with modern-day parenting. For the past few decades, discipline has become a dirty word. Given the increasing reticence to discipline a badly behaved toddler or impose sensible limits on a 15-year-old, is it any wonder that there are more badly behaved, wayward children? So-called progressive parenting says a parent should aim to be their child's friend rather than a parent who imposes draconian rules. The expectation is that a child will be a pint-sized adult with whom a parent can always reason. If only.

Two things are happening here. We end up glorifying a norm that suits parents and increasingly diagnose difference from that norm as a disorder. We seem to have forgotten that childhood behaviour naturally runs the full gamut that includes the consistently naughty, rebellious and rude.

Any family with more than one child can attest to the fact every child is different -- some placid, some defiant -- often exceedingly so. Reared in the same family, differences are often hard to manage and even harder to explain.

To suggest there is a norm from which any consistent deviation warrants a medical diagnosis points to another modern failing: the slow demise of personal responsibility. How much easier it is to slap a label on a wayward child than confront the need for parents to improve their parenting or expect a child to take responsibility for their actions.

And children are canny. Anorexia nervosa is a serious mental disorder. No one would suggest otherwise. But try telling your 14-year-old daughter to stop eating junk food and exercise more. The oft-heard refrain will be "you are going to turn me into an anorexic". We risk encouraging a generation of young children with no mental disorders to search out labels to avoid taking responsibility for their own behaviour.

But the lessons from the Macquarie University study don't end there. The study found that some schools in NSW "engaged in practices designed to inflate the level of student impairment" so that additional government funding flows to the school.

Linda Grant, one of the researchers from Macquarie University's Children and Families Research Centre, said this was part of an international trend of "gaming the system", where schools pursue extra funding by diagnosing behavioural problems.

The study's results are a lesson in the perverse incentives of poorly directed government handouts. When schools are given additional funding based on the number of disabled students, the rational response is to inflate the number of disabled children by relying on over-diagnosis of disorders with ambiguous criteria.

As the study found, parents wanting to enrol their troublesome child in a regular class are encouraged to "tick the highest boxes" in applications for support.

No matter what the problem, government handouts are never a risk-free panacea. Whether government is handing out subsidies to make a green car, offering welfare to indigenous people or supporting payments to schools for disabled students, the money risks creating its own set of perverse, unintended consequences. The trick is to target funding carefully to those in need, without creating a new set of problems. Allowing money to flow to an increasing range of childhood behaviours, over-diagnosed as disorders, does nothing for children who will walk around with damaging labels. More important, it does nothing for the disabled who genuinely need more support.

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